Consequences of disease outbreak significant

By now, most of us have seen the vivid images of the death and destruction wrought by the late-December Asian earthquake and tsunami in the Indian Ocean. Despite the ongoing play and replay of the heartwrenching footage, the shock remains.

Seasoned journalists, relief workers and diplomats on the ground in the hardest hit areas report having seen nothing like it. And few of us are able to grasp the severity of it all.
One of the gravest concerns in the aftermath of this historic natural disaster has been the likelihood of disease. Public health experts have been quick to warn the world that conditions are prime for diseases like cholera, which would further ravage a part of the world that is already coping with so much.

Considering the history

Into this context comes an update of an important book on the subject. “Plagues & Poxes: The Impact of Human History on Epidemic Disease” from Demos Medical Publishing is a gripping account of the history of major outbreaks of infectious and noninfectious diseases and the roles that we play in their development and spread.

Author Alfred Jay Bollet, M.D., well known for his “Civil War Medicine: Challenges and Triumphs,” has assembled 252 pages of clear writing to tell the stories of bubonic plague, influenza and yellow fever, as well as conditions like scurvy and gout. He also manages to delve into newer threats, including bioterrorism and the appearance of SARS.

Disease is an aspect of history often overlooked, but it is a critical factor for understanding both past events and the present time in which we live. It wasn’t until I read Bollet’s chapter on cholera that I came to understand the scope of the disease’s impact: Cholera is an infection of the gastrointestinal tract that can cause more deaths, more quickly, than any other epidemic disease.

Spread by contaminated water and food supplies, cholera can explode when large numbers of people share the same water source for drinking, cooking, bathing and waste disposal — a situation now common in many of the areas devastated by the tsunami.

Bollet’s telling of cholera at work is direct: True, or Asiatic, cholera characteristically causes extremely severe diarrhea with profuse watery stools that often contain white, rice-like particles (rice water stools). The resulting dehydration causes patients to collapse swiftly from falling blood pressure; the skin becomes shriveled, the pulse weak and thready, and the patient can become comatose within hours of the onset of the intense diarrhea, particularly when it is often accompanied by vomiting that aggravates the fluid loss. Circulatory collapse and kidney failure ensue, and death results.

Fluid replacement can counteract the effects, but are difficult to administer in large-scale outbreaks with limited medical resources and facilities.

While no serious disease situations have arisen among tsunami victims so far, it will be a challenge for public health workers to maintain reasonably sanitary conditions. With “Plagues & Poxes,” Bollet paints a grim picture of the consequences of the failure to do so.

And back to the aftermath

In the wake of the tsunami disaster, the world community has responded with generosity. Individuals and governments have pledged more than $2 billion for relief efforts. And the amount continues to rise.

If you’re looking for an aid organization to support, a few with online giving options include:

• The South Asia Relief Fund of Episcopal Relief & Development, on the Web at www.er-d.org.

• Save the Children, www.savethechildren.org.

• And Amazon.com has a link for the American Red Cross disaster relief efforts. Of course, it’s also important to remember local Red Cross chapters, which continue to have their own needs.

History shows us that large-scale events, like earthquakes, volcanoes and tsunamis, are simply a part of the earth’s natural processes. There is almost nothing to be done to control them, but there is much to be done — that must be done — in the aftermath.